Provider Demographics
NPI:1154816643
Name:MORAN, JEANNETTE LYNN
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:LYNN
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 JANET LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2728
Mailing Address - Country:US
Mailing Address - Phone:203-671-2072
Mailing Address - Fax:
Practice Address - Street 1:855 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3171
Practice Address - Country:US
Practice Address - Phone:203-876-0654
Practice Address - Fax:844-411-6456
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist